On July 1st, 1946, what is now known as the Centers for Disease Control and Prevention (CDC) officially opened in Atlanta, GA. What many may not know is that the CDC was started by medical officers of one of our country's uniformed services: the U.S. Public Health Service Commissioned Corps (USPHS). It was birthed from WWII and is considered by some to be the largest institutional legacy from the war.
The CDC's original name in 1946 was the "Communicable Disease Center;" however, much before that the CDC was spawned from something called the Malaria Control in War Areas (MCWA) program administered by USPHS. To understand MCWA and CDC, it's first important to understand a little about what malaria is.
Malaria is an infectious disease born from an Anopheles mosquito bite. The disease is caused by a parasite from the Plasmodium genus. The parasite infects the body's liver and red blood cells causing fever, chills, and an enlarged liver and spleen. In the most severe cases, fatality rates can reach 20%. Fun fact: the ancient romans created the name malaria or "mal" "aria" meaning bad air. They didn't know the cause of the disease and thought it it must be something in the air.
Malaria usually is found in tropical areas with standing water which is where mosquitoes like to live. There are more than 400,000 deaths per year from malaria, mostly in Africa. While there was a spike of malaria cases in the U.S. in the past couple of years, they were mostly from American travelers going East and bringing it back. Of note, more than 90% of those cases did not use chemoprophylaxis as recommended by current CDC guidelines!
One might think Malaria would be running rampant in some parts of the U.S. given the tropical and swampy regions of the Southeast, and he or she would be right--- if it were still the early 1940s.
Malaria and WWII
The presence of Malaria in the U.S. was problematic for soldier training. In 1940 the War Department (our modern day DoD) called on USPHS to organize public health activities in military camps and maneuver areas, most of which were in the South but also in Puerto Rico and the Virgin Islands. After the Pearl Harbor attack in 1942, funding was allocated to USPHS to begin the MWCA. It was organized under under the State Relations Division of USPHS (think feds working with state health departments) which was headed by medical officer Dr. Joseph Mountin. Dr. Mountin is often credited for creating CDC, but there were many key players.
One of which was USPHS medical officer and chief malari-ologist, Louis Williams Jr. Dr. Williams had prior malaria control experience in WWI so took the helm of MCWA initially. He was assigned in 1941 under the direction of USPHS medical officer Henry Rose Carter as liaison to the Army's most malaria-ridden station: the the 4th service command in Atlanta. In 1942 they achieved the lowest rate of infection in the Army at of 0.6 per 1000 men per year (Furman).
(Image: USPHS medical officer Henry Rose Carter inspecting malaria control activities circa 1915)
In June 1943, Williams was to be assigned to the Surgeon General of the Army to help prepare a war area in Algeria for the invasion of Italy, but a heart attack prevented him from going. Instead, he helped organize the mission from his bed!
(Image: Louis L. Williams Jr.)
MCWA Impact on War and Infectious Disease Expertise
From 1942 to 1943 MCWA served 900 and increased to 1161 war establishments for the Army and Navy throughout 21 states, DC, and PR. The MCWA approach involved collaboration between medicine, engineering, and entomology. It had over 3000 laborers for malaria control work supervised by engineers, entomologists, and physicians. Physicians treated cases in the field, but most of the work was done by engineers and entomologists. They drained swamps by digging ditches and larvicide a major emphasis starting with Paris Green, diesel oil, then DDT (DDT has been banned as of 1972).
During the war there were few malaria specialists so MCWA began its own training program. This essentially fed its own internal expertise for training on infectious disease which helped plant the seed for the eventual development of CDC. For example, in anticipation of troops returning from tropical areas, it expanded its training program to learn about tropical diseases like for Aedes aegypti to control yellow fever and dengue and then in 1944 expanded to typhus. In 1945 malaria control extended beyond just military areas to other regions. Also during this year, malaria was essentially eradicated from US with only occasional imported cases being reported.
In short, MCWA began with expertise in malaria and through its own internal training and experience, it naturally grew to control other infectious diseases. It began responding to state health departments requests for infectious disease concerns like amoeba in Alabama. It's important to remember that MCWA was under "state relation division" of USPHS, so it had the relationships to respond in this fashion.
End of WWII and Future of MCWA
As the war ended, Dr. Joseph Mountin (who was ultimately in charge of MCWA) wanted to create a "center" to help states eradicate infectious diseases. He didn't want it to compete with the National Institutes of Health (NIH), so he left the word “institute” out of the name. Mountin was prepared to debate his USPHS colleague and medical officer Dr. Rolla Dyer (NIH director) at a meeting with Surgeon General Thomas Parran, but Dyer agreed without reservation. CDC was to focus on disease control and NIH on research.
(Image: meeting of USPHS officers. Mountin is on far left and Dyer is next to him)
When the CDC began on July 1, 1946, engineer officer Mark Hollis was the 1st executive director as he was in charge of MCWA since 1944. Malaria was the focus in the first couple of years, but it soon added a veterinary division in 1947. It also took over the San Francisco Plague Laboratory (see story on Surgeon General Rupert Blue's plague campaign) whose epidemiology program became CDC’s epidemiology program. CDC became involved in other public health problems like diarrheal diseases and polio.
(Image: Hollis on far left and Mountin second from right)
In 1947 Emory University donated 15 acres of land on Clifton Rd to USPHS for a new center but due to delays, the new center wasn't fully ready until 1960. CDC's mission continued to broaden from insect control to medicine and biomedical science. Accordingly the number of medical officers increased from 7 in 1946 to 63 in 1952. Venereal disease programs were added in 1957 and tuberculosis in 1960. With the scope of CDC extending beyond infectious disease to nutrition, chronic disease, and occupational and environmental health, came name changes:
- In 1967, the name changed to National Communicable Disease Center
- In 1970 it changed to Center for Disease Control
- In 1980 it changed to Centers for Disease Control
- Finally in 1992 it changed to the Centers for Disease Control and Prevention
It's amazing to think that CDC is THE public health authority of the U.S. today after coming from a humble MCWA program in WWII. The effort and influence of Commissioned Corps on the creation of CDC should not be understated!
2. John Parascandola. From MWCA to CDC: Origins of the Centers for Disease Control and Prevention. Public Health Reports (1974-), Vol. 111, No. 6 (Nov. - Dec., 1996), pp. 549-551. Sage Publications, Inc
4. USPHS history book by Bess Furman